ANNEXURE IV - E

DECLARATION FOR RE-REGISTRATION

(IN CASE OF DELAY BEYOND 6 YEARS)

I __________________________ S/o, D/o, W/o, __________________

Resident of ________________________________________do here by
solemn oath state and affirm that I am not aware of any disciplinary
proceedings against me on the ground of a defect of character or of
infamous conduct in any professional respect nor I have been convicted
of any offence implying a defect of character.

DEPONENT

Verification: Verified at _____________ on this _______day

_______month ________year that the facts stated above are true and
correct to the best of my knowledge and belief.

Place:
Date: DEPONENT

[ON A NON-JUDICIAL STAMP PAPER TO BE ATTESTED BY A NOTARY PUBLIC]